Type II diabetes results from the body’s inability to produce sufficient
amounts of insulin and from the body’s resistance of insulin by fat and muscle
cells. In the latter case, the insulin secreted from the pancreas is unable to
properly connect with the cell, therefore, not letting glucose, which is
necessary for energy, in from the blood. As a result, blood glucose levels rise,
causing the pancreas to produce more insulin. The cells, however, in detecting
this glut of insulin, become even more resistant, leaving the afflicted person
with high glucose levels, often high insulin levels (http://www.upmc.edu/newsbureau/wpic/diabetes_prevention_program.htm),
and the inability to metabolize carbohydrates (http://home.judson.edu/academic/spinner/diabetes.html).

Lifestyle has been identified as the primary cause of type II diabetes. While
smoking and behavioral skills are major contributors, diet and exercise are the
main areas of concentration. By eating a healthy diet and exercising regularly,
one can delay, reverse, and ultimately prevent the onset of type II diabetes.
Even though genetics does play a part in the development of the disease, the
adoption of a healthy lifestyle can significantly suppress the expression of the
coded genes and, therefore, lessen a person’s chances of having to live a life
complicated with type II diabetes. As Dr. Allen Spiegel, director of the
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK),
commented, "Every year a person can live free of diabetes means an added year of
life free of the pain, disability, and medical costs incurred by this disease" (http://www.niddk.nih.gov/welcome/releases/8_8_01.htm).

In diseases, such as type II diabetes, that are completely dependent on the
proper functioning of the body on the cellular level, it is imperative to
capitalize on those actions that aid the cells in their processes. Diet and
exercise are such actions, seeing that each exerts tremendous influences on
cellular activity. Moreover, according to the American Diabetes Association, the
goal of any treatment plan for type II diabetics is to lower blood sugar and
improve the body’s use of insulin; diet and exercise have both proved efficient
in this regard (http://www.diabetes.org).

As stated by Christine Beebe, vice-president of the American Diabetes
Association, "Diet is the cornerstone of diabetes therapy" (http://home.judson.edu/academic/spinner/diabetes.html).
It carries the potential of balancing blood-glucose levels, establishing optimal
lipid levels, and providing "adequate calories for maintaining or attaining
reasonable weights in adults," three factors indispensable in treating type II
diabetes, according to the American Diabetes Association's technical review,
"Nutrition Principles for the Management of Diabetes and Related Complications"
(page 1). No one specific diet plan is recognized by this review, the American
Diabetes Association, or the American Dietetic Association; rather, experts are
advocating a well-balanced diet that is individualized for each patient.
However, general recommendations are being put forth. All of them closely
resemble that of the American Dietetic Association’s, which recommends that
60-70% of total energy intake be divided between monounsaturated fats and
carbohydrates, 10-20% be protein, 10% be saturated fat, no more than 10% be
polyunsaturated fat, and a cholesterol intake of less than 300 mg per day (Lipkin,
1999).

According to the "Nutrition Principles for the Management of Diabetes and
Related Complications," in type II diabetes, protein intake "may influence
metabolic control by altering gluconeogenic substrate availability as well as
insulin and counterregulatory hormone secretion." Also, in some type II
diabetics, the ingestion of protein with glucose can trigger a "synergistic
effect on the insulin secretion and a lower glycemic response than to glucose
alone" (page 3). Fats and carbohydrates alter glucose and lipid metabolism.
Fiber is known to aid in moderating blood sugar and blood-glucose levels and to
aid in lowering the triglyceride levels and blood pressure (http://home.judson.edu/academic/spinner/diabetes.html).
Low-fat, low-sugar, and high fiber foods slow the absorption of sugar into the
bloodstream, which then causes the amount of insulin needed to be reduced by two
or three units daily. In contrast, studies prove that when diabetics consume
what Americans consider "moderate" intakes of meats, high-fat dairy products,
and oils, the cell membranes become more resistant to insulin (http://www.cbn.com/partner/Article_Display_Page/0,,PTID2546%7CCHID102617%7CCIID135876,00.html).

In controlling type II diabetes, exercise is also essential. Exercise bears a
high potential of improving glucose tolerance, enhancing cardiovascular health,
reducing blood pressure and weight, and evoking positive changes in lipid
profiles, all of which are key factors in treating type II diabetics. With its
metabolic and cardiovascular benefits, exercise can significantly improve a
diabetic's quality of life (Bell, 1992).

In type II diabetes, high blood glucose levels represent insulin resistance.
Exercise increases insulin sensitivity and lowers body adiposity, which then
ultimately improves the regulation of glucose levels (N S Pierce,1999, page 1).
Exercise does this in several ways. First, it causes cells to demand glucose,
which then triggers them to respond more readily to glucose, even if inadequate
levels of insulin are present. Secondly, it causes an increase in insulin
receptors, which, in turn, reduces blood glucose levels (http://home.judson.edu/academic/spinner/diabetes.html).
Finally, the body naturally takes glucose out of the blood to use for energy
during and after exercise. In the end, not only does exercise increase insulin
sensitivity, but it also reduces the dose of insulin or oral medication needed
(http://diabetes.roche.com/features/featureOct00.html).

The claims made about lifestyle intervention and the prevention of type II
diabetes are strongly supported by the results of much in-depth research. A
study conducted in Finland followed 523 Finns, all of whom were overweight and
showed impaired glucose tolerance (IGT), a condition that generally precedes
diabetes. Half the cohort was given intense instruction from dieticians and
fitness professionals and given a free membership to a health club. The second
half of the group received initial advice about the importance of diet and
health, but no continual instruction. For two to six years, researches followed
the two groups. Not only did they find that those participants in the first
group were less likely to develop type II diabetes, but they also concluded that
by losing as little as 10 pounds, increasing exercise, and sticking to a healthy
diet, adults at high risk for type II diabetes could reduce their chances of
contacting the disease by 60 percent. (http://www.findarticles.com/cf_dls/m3225/8_62/65864184/p1/article.html).

Pan and Associates (1997) reviewed the Da Qing IGT and Diabetes Study which
also researched the efficacy of diet and exercise in preventing or delaying type
II diabetes in people with impaired glucose tolerance (IGT). After screening
110,660 men and women from 33 different health care clinics in Da Qing, China, a
cohort of 577 was selected, all having IGT, as defined by the World Health
Organization. The subjects were randomly separated into a control group and
three active treatment groups: diet only, exercise only, and diet-plus-exercise.
The participants in each group were categorized by body mass index (BMI); of all
the participants, 208 were found to be lean with BMI <25 kg/m2, and
332 were found to be overweight, with BMI >25 kg/m2.

In the diet group, each participant was prescribed a diet based on their BMI.
Lean participants were assigned a diet containing 25-30 kcal/kg body weight,
55-65% carbohydrate, and 10-15% fat and were advised to consume more vegetables,
control alcohol consumption, and reduce intake of simple sugars. Participants
with BMI > 25 kg/m2 were encouraged to reduce their calorie
intake to the point that they were losing weight at a rate of 0.5-1.0 kg per
month. They were to continue this until the target BMI of 23 kg/m2.
Thus, a unique diet plan was contrived for each participant, which outlined
individual goals for total calorie consumption and daily quantities of cereals,
vegetables, milk, meat, and oils. Each participant was counseled by a physician
on daily food intake and in addition, small-group counseling sessions were
conducted weekly one month, monthly for three months, and once every three
months for the remaining term of the study.

In the exercise group, the participants were educated about exercise and
encouraged to increase their amount of leisure physical exercise by 1-2 U/day,
depending on age, any evidence of any health problems other than IGT, and past
exercise patterns. The U represented one unit of exercise; a chart developed by
the study dictated the intensity and duration of activity required for this one
unit of exercise. In addition, all participants underwent the same schedule of
counseling as the diet group, except without the initial counseling by a
physician.

In the diet-plus-exercise group, participants received counseling on both
diet and exercise which closely followed the schedule of the other two groups
and were prescribed intervention tactics by the same standards as were followed
by the diet-only and exercise-only groups. In contrast, participants in the
control group received only general information about diabetes and IGT. Each
participant was given a brochure with guidelines regarding diet and exercise,
but no individual counseling was offered.

A six-year follow up of the study showed that the incidence of type II
diabetes was reduced by 33% in the diet-only group, 47% in the exercise-only
group, and 38% in the diet-plus exercise group; the incidence in the control
group was 20-25% less than any other of the other groups. In the diet-only and
diet-plus-exercise group, the estimated caloric intake was lower than the
initial value, and in the exercise-only and exercise-plus-diet groups the
average units per day of exercise was found to be significantly higher than at
the start of the research. Ultimately, the study showed that over a six-year
time period, changes in diet and exercise can considerably decrease the
incidence of type II diabetes.

Other research has also been conducted in which the effects of diet and
exercise on type II diabetes examined independently of one another. N S Peirce
reviewed (1999) a number of such studies that concentrated solely on exercise
and diabetes. He used the method of assessing sources through Medline, BIDS, and
SportDiscuss from 1966 to 1998, and then cross referencing the material and
considering the opinions of diabetologists and athletes to produce a thorough
analysis of the relationship between exercise and diabetes. The review, based on
strong and accurate evidence, (the major studies analyzed are already presented
in this paper) overwhelmingly affirmed exercise as a potent strategy for the
prevention and treatment of type II diabetes.

In another study, which focused just on diet, five men with normal glucose
and insulin levels were given a lipid infusion to raise their levels of free
fatty acids to levels considered "normal" for the typical American. Within two
hours, all of the men had diabetes. Another research team conducted a similar
study, but this time with four different groups, each set on a different diet –
the first, high protein, the second, high fat, the third, no food, and the
fourth, high carbohydrates. At the end of two days, only the high carbohydrate
group maintained normal glucose levels; those individuals in the first group
showed definite signs of diabetes, while those in the third group had fully
developed the disease (http://home.judson.edu/academic/spinner/diabetes.html).In yet another study, eighty newly diagnosed type II diabetics who
required insulin were placed on a sugar-free, 12% fat diet. Within six weeks of
the study, 62% no longer required insulin and after eighteen weeks, 72% were
completely free of the disease (http://home.judson.edu/academic/spinner/diabetes.html).

A research team, lead by Dr. Frank Hu of the Harvard School of Public Health,
conducted a major ADA funded research study in which they followed 84,941 female
nurses from 1980 to 1996, closely examining how the combined effect of diet and
lifestyle contributed to the onset of type II diabetes mellitus in women (Hu et
al., 2001). All the women were free of diagnosed cardiovascular disease,
diabetes, and cancer at the base line, and information concerning individual
diet and lifestyle was updated periodically through questionnaires. Based on
questionnaire responses, a low-risk group was established according to a
combination of variables, including a diet high in cereal fiber and
polyunsaturated fat and low in trans-fat and glycemic load and engagement in
moderate-to-vigorous physical activity for a minimum of thirty minutes per day.

The results showed that compared to the cohort as a whole, the women in the
low-risk group had a 0.09 relative risk of developing type II diabetes. In
addition, the study found that 91% of the developed cases of type II diabetes
could be attributed to behavior not consistent with the low-risk pattern.
Although the study found body mass index to be the most important risk factor,
the study strongly acknowledged diet and exercise as major risk factors; it was
even found women who exercised for less than thirty minutes weekly were twice as
likely to develop type II diabetes as those who exercised for seven or more
hours per week. (http://us.news2.yimg.com/f/42/31/7m/dailynews.yahoo.com/h/nm/20010912/sc/health_diabetes_dc_2.html).

The results of one study not only proved that exercise is effective in
treating type II diabetes, but also determined the specific intensity and
duration of physical activity necessary for exercise to be potent in combating
the disease. The study analyzed 897 Finnish men and after adjustment for age,
base-line glucose values, body mass index, serum triglyceride levels, parental
history of diabetes, and alcohol consumption, found that moderately intensive
physical activities, in those that were 5.5 metabolic units or higher and
undertaken for at least 40 minutes per week, reduced the risk of developing
non-insulin-dependent diabetes mellitus (NIDDM) by 50%. Activities with less
than an intensity of 5.5 metabolic units did not prove protective, regardless of
their duration. The study offered brisk walking on soft surfaces, slow swimming,
light bicycling, aerobic dance, ball games, and commercially available exercise
equipment all as examples of activities that would constitute an intensity of
5.5 metabolic units or greater. Moreover, the study showed that cardiovascular
fitness levels greater than 31.0 mL of oxygen per kilogram per minute were
protective against the onset of NIDDM and that exercise is also effective in men
at high-risk of NIDDM. The study found that a subgroup of men who were
categorized as high-risk due to being overweight, hypertensive and having a
positive parental history of NIDDM, through exercising over 40-min/wk duration
at intensities greater or equal to 5.5 metabolic units, were able to reduce
their risk of developing NIDDM by 64% compared to men who did not engage in such
activities. Clearly, physical activity and exercise play a major role in the
onset and managing of type II diabetes (Cohen et al., 1995).

Of all the studies and research conducted, perhaps the most convincing and
cogent findings came from a major clinical trial conducted by the Diabetes
Prevention Program (DPP). It is a known statistic that different minority groups
suffer disproportionately from type II diabetes; compared to whites, the disease
is 50% more prevalent in African Americans and is 100 – 200% more prevalent in
Hispanics (Martin et al ., 1995). Among other minorities subject to a
disproportionate affliction rates are Asian Americans, Pacific Islanders, and
American Indians. These minorities mentioned accounted for 45 percent of the
3,234 individuals the DPP followed in their study. The research team randomly
assigned the cohort into two different groups – one to test the effectiveness of
a potential drug and the other to test the effectiveness of lifestyle
intervention.

Overall, the results of the second group echoed those of past studies,
showing that those who ate healthier and exercised for just thirty minutes
daily, reduced their risk of developing type II diabetes by 58 percent. What
sets this study apart from the rest, however, is that its results prove that
lifestyle intervention – namely diet and exercise – is just as effective in men
and as it was in women and all the different ethnic groups. In addition, the
results showed that in people age 60 or older, among whose prevalence for type
II diabetes is 20 percent, their chances of developing the disease could be
reduced by 71 percent through adapting their lifestyle (http://www.niddk.nih.gov/welcome/releases/8_8_01.htm).

Further studies prove not only that diet and exercise work, but that they are
feasible forms of intervention as well. Barnard, Jung, and Inkeles' review
(1994) of study in which a team of researchersestablished an intensive
diet and exercise program and then investigated its effectiveness in controlling
type II diabetes. The study identified 652 patients from 19 to 83 years of age,
all of which had NIDDM. Of the cohort, 212 were taking insulin and 197 were
taking oral hypoglycemic agents. All the patients participated in a 26-day
lifestyle intervention program; the research team closely monitored their
responses to it.

The program included daily aerobic exercise, primarily walking, and a
high-complex-carbohydrate, high-fiber, low-fat, low-cholesterol, and low-salt
diet, containing 35-40 g of dietary fiber per 1,000 kcal and a total daily
intake < 4g of sodium chloride and < 25 mg of cholesterol. Of the total
dietary calories, <10% were from fat, 15% were from protein, and the rest were
from carbohydrates. The results showed that among the total cohort, fasting
glucose levels were reduced from 10.0 to 8.45 mmol/l, serum total and
low-density lipoprotein cholesterol were reduced by 22%, triglyceride levels
were reduced by 33%, and the ratio of high-density lipoprotein cholesterol was
reduced by 13%. At the end of the program, 39% of the 212 patients initially
taking insulin and 71% of the 197 subjects initially taking oral hypoglycemic
agents were all able to discontinue their medications. In addition, blood
pressure was reduced considerably; of the 319 patients originally taking
antihypertension drugs, 34% were able to discontinue their medications.

Not only did the program prove itself a success, but the results
overwhelmingly showed that diet and exercise are absolute factors in controlling
type II diabetes mellitus, and thus should be an integral part of any treatment
therapy. In addition, the aftermath of the study presented two notably
significant advantages of using diet and exercise as treatment. The first is
that because the lifestyle interventions were so effective that overall health
was improved and patients initially on medication and insulin were able to
discontinue their usage, diet and exercise have the potential of dramatically
lessening the medical costs of both the disease and its complications. The
second advantage is that statistical evidence produced in the study showed that
compliance rates are high with diet-exercise intervention; in the 2- to 3-year
follow-up study, the majority of patients both continued the program and kept
their diabetes under control.

A study conducted in Malmo, Sweden (Eriksson and Lindgarde,1991) not only
resounded the effects diet and exercise have on type II diabetes, but also
reinforced the feasibility of the interventions. Researchers performed a
five-year prospective study, selecting 41 subjects with early-stage NIDDM as
group one, 181 subjects with IGT as group two, 79 non-randomized subjects with
IGT as group 3, and 114 randomly selected subjects with strictly normal OGTT as
group 4. Groups one and two were enrolled in an intervention program at local
clinics, which focused heavily on dietary advice and increase of physical
activity, yet with no extreme resources being implemented. The participants were
monitored through periodic check-ups. At the end of the study, 53.8% of the
participants in the type II group (1) showed improved glucose levels and
increased insulin sensitivity and were in remission. In the IGT group (2), 75.8%
of the participants had improved their glucose tolerance and significantly
increased insulin sensitivity, and only 10.6 % of group two had progressed to
type II diabetes. The relative risk of the development of type II diabetes in
group two compared to group three was found to be 0.37. In group four, no cases
of diabetes were evident. Blood pressure was found to have been reduced in
groups one, two, and three, yet a greater percentage of participants in group
two than in group three were able to discontinue use of medication. In addition,
the total plasma cholesterol dropped significantly in group one patients, lipid
metabolism was improved in group two by a considerable reduction in type IV
hyperlipidaemia, and serum triglycerides were substantially reduced in groups
one and two, and increased in group three.

Furthermore, the drop-out rate for the 5-year intervention program was less
than 10 %. This value is largely significant noting that the treatment groups
(groups one and two) consisted of a representative sample of glucose tolerant
subjects in the cohort, and not just a group of volunteers. Thus, the
researchers concluded not only that diet and exercise were powerful forms of
intervention, but also that the intervention program with a simple check-up
process and moderate input of resources, could, in fact, be carried out on a
large-scale community basis.

Evidence leaves no question that diet and exercise are effective and valuable
intervention tactics. Thus, it would seem that diet and exercise are the simple
solution to a major problem. However, overlooking the individual and social
factors that impede adherence would be an largely unfair to those patients who
struggle with self-managing programs.

Many of the studies took extraordinary measures to make sure the programs
were as accessible and as encouraging as possible, such as frequent counseling
visits, gym and work-out equipment available free of charge, and rigid meal
plans. However, these and like measures, are not realistic to most who turn to
diet and exercise for treatment of type II diabetes, thus making the integration
of diet and exercise into one’s lifestyle far more difficult. In a 2001 issue of
Journal of Community Health Nursing, researchers reported that despite
the fact that diet and exercise are the essential components in controlling type
II diabetes, they are the areas which patients find most difficult to comply and
self-manage. The researchers conducted a study in which through mail, they
surveyed 97 NIDDM patients from three eastern Washington area hospitals and 143
diabetes educators from the Washington Area Association of Education (WADE) on
the difficulty of adhering to diet and exercise intervention programs. The
patient and educator surveys both deemed the difficulty of maintaining a diet
away from home and liking foods outside the meal plan to be the greatest
inhibitors of self-managing a diet program, and weather and physical activity
not being high priority as the greatest inhibitors of self-managing an exercise
program. Another study, appearing in a 2000 Diabetes Care supplement,
investigated the "limitations to treatment compliance of diabetes patients"
(page 1). The study followed 354 diabetic patients, who were the total
attendance to outpatient visits during one month at three different medical care
centers; all patients were initially interviewed and a scale was developed to
report compliance rates. It was found that, through the course of the study,
diet had a 9.58% compliance, administration of insulin, a 39.13% compliance, and
oral hypoglycemic agents, a 40.9% compliance, with the main limitation reported
in these three treatments being cost. Of the subjects, 25.42% engaged in regular
physical activities; those that did not, claimed unwillingness, physical
disabilities, and insufficient knowledge as the greatest limitations. In all,
5.93 % of the participants had a total compliance, 52.54% had a partial
compliance, and 41.53% had no compliance. The study concluded that "appropriate
treatment compliance is low and that economic and social factors are the main
limitations to achieve it" (Gutierrez & Rivas).

Fortunately, the medical field has identified the many difficulties patients
have with compliance and are striving to develop methods to improve adherence.
In the study, "Psychosocial Predictors of Self-Care Behaviors (Compliance) and
Glycemic Control in Non-Insulin-Dependent Diabetes Mellitus" researchers were
able to isolate (in order of importance) health beliefs, social support,
knowledge, anxiety, and depression as the "psychosocial variables most
predictive of adherence and establish suggested guidelines for physicians to
follow in treating patients (Wilson and Associates, 1986). In 1999, another team
of researches assessed the effect of behavioral science on self-management and
patient empowerment in type II diabetics, with the conclusion that changes are
required on the part of behavioral scientists and other health professionals in
how they organize and present research and preventive therapies (Anderson et
al., 1999). The Diabetes Control and Complications Trial (DCCT), found that
"individualization of the intensive regimen, ongoing staff support, and
follow-up contact" are central to improving adherence (Glasgow & Associates,
1999, page 1), and the "Physician and Patient Prevention Practices in NIDDM in a
Large Urban Mangaged-Care Organization" study found that "improved access to
preventive services may be effective in reducing" the adherence gap between
different ethnicities and races. The researchers here studied 378 NIDDM patients
who were members of the Kaiser Permanente Medical Care Program in Oakland,
California in a cross-sectional chart review study of prevention practices,
complications, and risk factors. Of the cohort, 232 were blacks, 81 were whites,
29 were Hispanics, and 36 were of other races and ethnicities (Martin et al.,
1994, page 1). Furthermore, the American Diabetes Association, in it's review,
"Diabetes Mellitus and Exercise," (2001) reported that adherence rates were
highest in studies that implemented an initial period of supervision proceeded
by moderately intense regular exercise program, that included regular and
frequent follow-up assessments (http://www.diabetes.org/clinicalrecommendations/Supplement101/S51.htm).

The health profession is yielding the advice produced by research studies and
is trying to implement the findings in treatment plans. Such examples are that
the Division of Diabetes Translation is developing a distinct section of
behavioral science, and in all 50 states, the Disease Control Programs, funded
by the Disease Control and Prevention and Center (CDC’s) have invited behavioral
scientists to become involved in their state’s program (Glasgow & Associates et
al., 1999). Thus, action is being taken to improve adherence and therefore,
enhance the effectiveness of diet and exercise intervention in type II
diabetics.

Promoting a well-balanced diet and regular exercise program are essential
components of health, regardless of whether a person is diabetic. A nutritional,
well-balanced diet not only improves overall health and reduces the risk of
long-term complications of type II diabetes such as renal disease, autonomic
neuropathy, hypertension, and cardiovascular disease, but also significantly
reduces the risk of chronic diseases such as obesity and dyslipidemias, that are
on the rise in America today (Beebe et al., 1994). Although no specific diet has
been set, all recommendations by the American Dietetic Association and American
Diabetes Association are done so on the basis of maintaining and enhancing
overall health.

Exercise, however, despite its proven ability to control glycemic levels and
reduce the risk of cardiovascular disease, hyperlipidemia, hypertension,
fibrinolysis, obesity, and type II diabetes, is not without risk for some
patients. For example, for type II diabetics that are on insulin or undergoing
sulfonylurea therapy, exercising when there not sufficient insulin circulating
in the blood, due to inadequate therapy, increase glucose levels and ketone
bodies and even initiate diabetic ketoacidosis. In contrast, if there is an
excessive amount of insulin in the blood, exercise may inhibit proper
mobilization of glucose and other exercise-induced substrates, thus, greatly
increasing the risk of hypoglycemia. In order to best protect patients, a
detailed and thorough evaluation complete with diagnostic studies must be done
before any exercise program is recommended. The evaluation should determine if
the patient shows any signs or symptoms of diseases that affect the circulatory
or nervous systems, such as cardiovascular disease, peripheral arterial disease,
retinopathy, and nephropathy, both peripheral and autonomic. In the event that
evidence of such a disease is identified, an exercise program must be especially
constructed to minimize the risk to the patient, seeing that certain forms and
intensities of exercise could complicate the disease symptoms (2001). In any
exercise program, however, the American Diabetes Association recommends a proper
warm-up and cool-down consisting of 5-10 min of aerobic activity at a
low-intensity level, proper stretching for 5-10 min after the warm-up. It also
recommends that precautionary measures, such as silica gel or (blend)
cotton-polyester socks, be taken in order to protect the feet from blisters and
too much moisture, that proper hydration be practiced, due to the adverse effect
dehydration can have on blood glucose levels and heart function, that hydration
be properly maintained prior to exercise, and that high-resistance exercise be
avoided for older individuals with long-standing diabetes (http://www.diabetes.org/clinicalrecommendations/Supplement101/S51.htm).

The evidence supporting the claims that diet and exercise are directly
related to the development of type II diabetes is backed by sources that are
both credible and sound. The researchers and medical organizations at the
forefront of the issue, promoting such claims, are among the most respectable in
the country. They include the Diabetes Prevention Program, the National
Institutes of Health, the Centers for Disease Control and Prevention, the
American Academy of Family Physicians, Harvard School of Public Health, the
American Diabetes Association, and the Senate Select Committee on Nutrition and
Human Needs, and others. In addition, the science journals and newspapers
reporting the findings are held in high regard by the medical field. Such
sources includethe National Library of Medicine, the New
England Journal of Medicine, and U.S. News.

The research organizations conducting the studies were not driven by profit
or product sales; rather, they were motivated by the desire to find effective
treatments and potential prevention tactics. These organizations and research
teams are focused on preserving health and advancing the medical frontier, not
in enticing customers. They present the findings to the public with the hope
that the newfound knowledge might provoke lifestyle changes, which could
ultimately reduce the number of people forced to live with type II diabetes.

According to a recent statistic, over 150 million people worldwide are
afflicted with diabetes, and diabetes organizations are estimating that the
number will be up to 300 million by 2005 (http://heartinfo.org/reuters2000/001114elin047.html).
Fortunately, viable medical research has proved that there are indeed measures
that can be taken to lessen the prevalence of the disease. The measures are as
simple as eating a balanced diet and exercising regularly. Thus, the prevention
and suppression of type II diabetes through diet and exercise are absolutely and
completely feasible. Moreover, this correlation between lifestyle intervention
and type II diabetes is merely a reflection of Dr. Denis Burkitt’s statement
that, "Health is not determined by doctors of medicines; health is determined by
the way we live" (http://home.judson.edu/academic/spinner/diabetes.html).